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WI-RBS-Wisconsin Simplified Application

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WI-RBS-Wisconsin Simplified Application Powered By Docstoc
					    United State Department of Agriculture
              Rural Development

                 Section 9007
       Rural Energy For America Program
 Renewable Energy Systems and Energy Efficiency
              Improvement Grants

         Simplified Grant Application Template

The simplified grant application template—on the following pages—provides access to fillable
forms and a framework of divider pages to organize the grant application for submission to
USDA-Rural Development. Please tab the divider pages as indicated.

Other tools are available on the Wisconsin Rural Development Business and Cooperative
Program website at: http://www.rurdev.usda.gov/WI_RBS_Energy.html


Separate applications must be submitted for renewable energy system and energy efficiency
improvement projects. Applicants may only submit one application for each type of project per
fiscal year.


An original and 1 copy of the application must be submitted to:

                       USDA Rural Development
                       5417 Clem’s Way
                       Stevens Point, WI 54482

A simplified grant application has total eligible project costs of $200,000 or less and can
involve commercial technology only.



 Eligible project costs are only those costs directly associated with the project that are incurred
                   after the application is received by USDA/Rural Development

                                                    .


  This template is designed for training and education and does not replace the 4280-B regulation.




                                       Page 1                                Revised 1/17/13
               USDA-Rural Development

                Section 9007
      Rural Energy For America Program
Renewable Energy Systems and Energy Efficiency
             Improvement Grants

             Simplified Grant Application

Title of Project:
Address of Project:

                          Submitted by

Applicant Name:
Address:
City:
County:
State:
Zip code:
Phone #:     (        )            -
E-mail:
Fax:      (    )             -

                    Choose One:
          A Renewable Energy Systems Project
            (including Flex Fuels Systems)
                           or
        An Energy Efficiency Improvements Project


               $             Grant Request

             Combo/Grant Writer Name
             Phone #     E-mail
              Date Submitted to RD:
                          Page 2             Revised 1/17/13
                            Section 9007 Simplified Application

                                           Table of Contents
                                           (Title of the Project)

4280.116 (b) (2) A detailed table of contents in the order presented below with clear pagination and chapter
identification. The table of contents will include page numbers for each component of the proposal.
Begin pagination immediately following Table of Contents.


                               Simplified Grant Application Components                                  Tab

 I.     Title Page

 II.    Table of Contents

III.    Project Specific Forms                                                                           A
            A. SF 424 – Application
            B. SF 424c – Budget
            C. SF 424d – Assurances
            D. RD 1940-20 – “Request for Environmental Information” and attachments

IV.     Certifications                                                                                   B
           A. AD 1049 or AD1050
           B. AD 1048
           C. Exh. A-1, 1940-Q – only required for grants exceeding $100,000
           D. Form SF-LLL
           E. AD 1047
           F. RD 400-1
           G. RD 400-4
           H. Guide 6 – Certification Regarding Qualification for Simplified Grant Applications
                4280.109
           I. AD 3030 (except LLC’s)
           J. AD 2106

 V.     Legal organizational documents (including contracts with investors)                              C

VI.     Project Summary                                                                                  D
            A. Title of Project
            B. Applicant Eligibility
            C. Project Eligibility
            D. Operation Description
            E. Financial Information for Size Determination

VII.    Matching Funds Documentation                                                                     E

VIII.   Self Evaluation Score                                                                            F
               Documentation is tabbed to match the scoring criteria numbering

IX.     Energy Audit (if project is an energy efficiency project)                                        G

 X.     Technical Report                                                                                 H




                                              Page 3                             Revised 1/17/13
                                                      Tab A
                                                    Divider Page

Federal Tax ID #
DUNS #
To get a DUNS number, call 1-800-234-3867 or go to
www.dunandbradstreet.com/US/duns_update/index.html
CENTRAL CONTRACTOR REGISTRATION (CCR)
In accordance with the Federal Funding Accountability and
Transparency Act (2 CFR, PART 25) Federal agencies must require
applicants other than individuals, with some specific exceptions, to
have Dun and Bradstreet Data Universal Numbering System
(DUNS) numbers and maintain current registrations in the Central
Contractor Registration (CCR) database.
CCR registration must be renewed annually. Information needed to
complete the CCR registration can be found at:
https://www.sam.gov/portal/public/SAM/

                         Project Specific Forms 4280.116 (b) (1) (i) A, B, C, D
                        These forms can be found on the Wisconsin Website at:
                            http://www.rurdev.usda.gov/WI_RBS_Energy.html


SF 424 – Application for Federal Assistance
SF 424C – Budget Information
To provide a more itemized breakdown of eligible and ineligible expenses,
attach a separate spreadsheet
SF 424D – Assurances
RD 1940-20 – Request for Environmental Information –
and documentation
The environmental documentation will vary depending on the project.
Complete the first page of 1940-20 and sign it. Consult with the Rural
Development State Office Specialist if you have questions regarding
documentation needed.
Examples of Projects:                                       Documentation:
Categorical Exclusion of Environmental Assessment           --legal description of site where project will be located
-- Crop drying equipment                                    --statement of project- who wants to do what, where, when,
--Improvements to a facility or process to reduce energy    and how
consumption (Lights, HVAC, freezers, coolers, etc.)         --site photo
-- Solar voltaic systems                                    --map or aerial photo with the project identified
--Flex Fuel Systems
Class I Environmental Assessment                            --Subsequent to the first page of the 1940-20 –Answer
--Solar thermal- small ponds, receivers                     question 1,2,13,15,16,17- attach third party documents as
--small wind turbines less than 100kW and hub height less   appropriate & provide legal description
than 120’                                                   --Site photos
                                                            --Discussion of alternative sites considered
                                                            From NRCS office
                                                            --USGS topographical map
                                                            --Aerial ortho photo- identify exactly where the project will
                                                            be located
                                                            If Wind project:
                                                            --Photo in all 4 directions from the turbine site
                                                            --Schematic of where electrical line to be located.



                                        Page 4                              Revised 1/17/13
                                             Tab B
                                           Divider Page


                         Certifications 4280.116(b) (1) (i) A through H

These forms can be found on the Wisconsin Website at:
                                                                                     Please indicate:
                                                                                     X (enclosed) or
         http://www.rurdev.usda.gov/WI_RBS_Energy.html                             N/A (not applicable)
         Insert the forms immediately after this divider page

AD 1049 Certification Regarding Drug Free Workplace Requirements
(Grants) Alternative 1 – “For Grantees other than Individuals”

AD 1050 Certification Regarding Drug Free Workplace Requirements
(Grants) Alternative II – “For Grantees Who Are Individuals”

AD 1048 Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion – Lower Tiered Covered Transactions

Exhibit A-1 of 1940-Q Certification for Contracts, Grants and Loans – if
                                                                                          N/A
the grant exceeds $100,000

Form SF-LLL Disclosure of Lobbying Activities; must be completed if the
applicant or borrower has made or agreed to make payment using funds
other than Federal appropriated funds to influence or attempt to influence
a decision in connection with the application.

AD 1047 Certification Regarding Debarment, Suspension, and Other
Responsibility – Primary Covered Transactions

Form RD 400-1 Equal Opportunity Agreement



Form RD 400-4 Assurance Agreement

Guide 6 – Certification Regarding Qualification For Simplified Grant
Applications – 4280.114.

AD 3030 Representations Regarding Felony Conviction and Tax
Delinquent Status for Corporate Applicants (except LLC’s)

AD 2106 Form to Assist in Assessment of USDA Compliance With Civil
Rights Laws




                                         Page 5                              Revised 1/17/13
Guide 6 to 4280-B               Certification Regarding Qualification
                               For Simplified Grant Applications 4280.114
WHEREAS,           , herein called the “Grantee”, intends to obtain assistance from the United States of America,
acting through the U.S. Department of Agriculture, herein called the “Agency”, acting under the provisions of the
Renewable Energy Systems and Energy Efficiency Improvements Grant Program 4280-B regulations.

NOW THEREFORE, the Grantee hereby certifies the following simplified application criteria have been or will be
met:

        (1) The grantee (applicant) is eligible in accordance with 4280.112. (Guide 5)
        (2) The project is eligible in accordance with 4280.113.
        (3) Total eligible project costs are $200,000 or less. The total eligible cost of my project is $ .
        (4) The proposed project will use commercially available renewable energy systems or energy efficiency
            improvements.
        (5) Construction planning and performing development will be performed in compliance with 4280.119.
            The grantee or the grantee’s prime contractor is responsible for all interim financing.
        (6) The grantee or the grantee’s prime contractor is responsible for all interim financing.
        (7) The proposed project is scheduled to be completed within 24 months after entering into a grant
            agreement. The Agency may extend this period if the Agency determines, at its sole discretion, that the
            applicant is unable to complete the project for reasons beyond the applicant’s control.
        (8) The grantee agrees not to request reimbursement from funds obligated under this program until after
            project completion, including all operational testing and certifications unacceptable to the Agency.

IN ADDITION, the Grantee hereby certifies the following application processing and administration requirements
have been met and/or are agreed to:

    (1) Applications documents have been submitted in accordance with 4280.116, or if applying for a combined
        grant and loan, also in accordance with 4280.165 (c).
    (2) The grantee certifies that project development will follow 4280.115, except as follows:
            a.       The grantee will participate in project development without direct compensation subject to
                 approval in writing by the prime contractor. All applicable construction practices, manufacturer
                 instructions, and all safety codes and standards will be followed during construction and testing,
                 and the work product must meet all applicable manufacture specifications, and all applicable codes
                 and standards. The prime contractor will be responsible for the overall successful completion of the
                 project including any work done by the grantee, or
            b.       The grantee can demonstrate to the Agency that the grantee has the necessary experience and
                 other resources to successfully complete the project and may serve as the prime
                 contractor/installer. Projects where the grantee serves as the prime contractor will secure the
                 services of an independent, professionally responsible, qualified consultant to certify testing
                 specifications, procedures and testing results.
    (3) The project is complete when the grantee has provided a written final project development, testing, and
        performance report acceptable to the Agency. Upon notification of receipt of an acceptable project
        completion report, the grantee may request grant reimbursement. The Agency reserves the right to observe
        the testing.
    (4) National flood insurance is required, if applicable. Business interruption insurance is not required.

    I have executed this certification on this       day of      , 20       .

    _______________________________                               ________________________________
    Name of Applicant                                             Authorized Representative of Applicant




                                                 Page 6                            Revised 1/17/13
                    Tab C
                  Divider Page


Legal Organizational Documents 4280.116 (b) (iii)




                  Page 7                      Revised 1/17/13
                                                         Tab D
                                                      Divider Page


                           Project Summary 4280.116 (b) (3) (i) through (v)


Title of the Project

Applicant Eligibility (as per 4280.112)

Project Eligibility (as per 4280.113)

Operation Description

Financial Information for Size Determination


IRS Forms                                                                                      D-1

NAICS code information if applicable                                                           D-2

Documentation of commercially available                                                        D-3

Third party contracts for management and maintenance                                           D-4
(if applicable)

Evidence of site control                                                                       D-5


 An agricultural producer is an individual or entity directly engaged in the production of agricultural products, including
 crops (including farming), livestock (including ranching), forestry products, hydroponics, nursery stock, or aquaculture,
 whereby 50% or greater of their gross income is derived from the operations. 50% or greater of gross income is
 determined as follows:
                                          Line 9 of IRS form Schedule F divided by
            (Line 22 IRS form 1040) + (Line 33 of IRS form Schedule F) + (Line 28 and 30 from Schedule C)

 Attached are previous year IRS forms to confirm the computation (Exhibit D-1).



 An entity is considered a small business in accordance with the Small Business Administrations (SBA) small business
 size standards by NAICS found in Title 13 CFR Part 121. A private entity including a sole proprietorship, partnership,
 corporation, cooperative (including a cooperative qualified under Section 501 (c) (12) of the Internal Revenue Code),
 and an electric utility including a Tribal or Governmental electric utility that provides service to rural consumers on a
 cost of service basis without support from public funds or subsidy from the government authority establishing the
 district, provided such utilities meet SBA’s definition of small business. These entities must operate independent of
 direct Government control except for Tribal business formed as Section 17 Corporations as determined by the
 Secretary of the Interior or other Tribal business entities that have similar structures and relationships with their Tribal
 governments as determined by the Agency. The Agency shall determine the small business status of such a Tribal
 entity without regard to the resources of the Tribal government. With the exception of the entities described above, all
 other non-profit entities are excluded. With the exception of the entities described above, all other non-profit entities
 are excluded. See this website for SBA’s size standards and for more information: http://sba.gov/content/table-small-
 business-size-standards/



                                                       Page 8                                      Revised 1/17/13
Guide 5               Section 9007 RURAL ENERGY FOR AMERICA Program Applicant & Project Eligibility

Applicant Name:
Title of Project:
Type of Technology:        Renewable Energy (including Flex Fuel Systems) or             Energy Efficiency

                                         Applicant Eligibility (4280.112)

        WHEREAS,            herein called the “Grantee/Applicant”, intends to obtain assistance from the United
States of America, acting through the U.S. Department of Agriculture, herein called the “Government”, acting under
the provisions of the Section 9007 Rural Energy for America Program.

           NOW THEREFORE, in consideration of the premises, the Grantee hereby certifies to their applicant
eligibility as follows (for any not applicable, mark N/A):

1.     If applying as an Agricultural Producer – more than 50% of the grantee’s income is from agricultural
        production. (Documentation is attached to show more than 50% of gross income is from the farming
        operation – first page of previous year income tax return and schedule F).

       If applying as a Rural Small Business – the grantee’s business meets SBA small business size Standards
          http://sba.gov/content/table-small-business-size-standards/

        The NAICS code for my business is
        The limitations of the NAICS code are
        How my business meets those limitations
             Documentation is attached to show how my business meets those limitations –
        If business size is based on annual sales one of the following:
                 IRS 1040 Schedule F         IRS 1040 Schedule C         IRS Form 1120
                 IRS Form 1120S              IRS Form 1065

2.        (Answer True or False) The grantee has no outstanding judgment from Federal Court, is not delinquent in
          federal income taxes or federal debt, and has not been debarred from receiving federal assistance.

3.        (Answer True or False) I have received a Section 9006 or 9007 grant in prior years.
          If the answer is true – please indicate the year    and type of project        .

The grantee     does or      does not have a known relationship or association with an Agency employee. If
applicable, name and relationship of employee:


IN WITNESS WHEREOF, I have executed this certification on this           day of       , 20      .


                                                _____________________________________________
                                                Name of Applicant/Grantee

                                                _____________________________________________
                                                Printed Name of Authorized Representative of Applicant/Grantee

                                                _____________________________________________
                                                Signature of Authorized Representative of Applicant/Grantee




                                             Page 9                               Revised 1/17/13
                                                Project Eligibility (4280.113)

        WHEREAS,            herein called the “Grantee/Applicant”, intends to obtain assistance from the United
States of America, acting through the U.S. Department of Agriculture, herein called the “Government”, acting under
the provisions of the Section 9007 Rural Energy for America Program.

         NOW THEREFORE, in consideration of the premises, the Grantee hereby certifies to their project eligibility
as follows (for any not applicable, mark N/A):

1.      Type of Technology:         Renewable Energy (including Flex Fuel Systems) or                        Energy Efficiency
        The project description is:

2.      The project is for      Commercially available and replicable technology
                                Pre-Commercial and replicable technology

          Pre-commercial technology – Technologies that have emerged through the research and development process and
          have technical and economic potential for commercial application, but are not yet commercially available.

          Commercially available – A system that has a proven operating history specific to the proposed application. Such a
          system is based on established design, and installation procedures and practice. Professional service providers,
          trades, large construction equipment providers, and labor are familiar with installation procedures and practices.
          Proprietary and balance of system equipment and spare parts are readily available. Service is readily available to
          properly maintain and operate system. An established warranty exists for parts, labor and performance.


            Documentation is attached to support the commercial availability of the technology in my application.

3.       The project has technical merit (Answer yes or no).

4.         The project is located in a rural area, as defined in 4280.103 (Answer yes or no).
            The project will be located in       .
            The address is         .
            The most recent decennial population census of the project location is            .
            The project      is or     is not located in an urbanized area.
           If applicant is an agriculture producer and the facility is located in a non rural area, the subject renewable
installation or efficiency improvement are an integral component of or are directly related to the facility, such as
vertically integrated operation, and are part of and co-located with the agriculture production operation. (Yes or No)

5.      The owner of the project is        .
        Is the owner of the project the same entity as the applicant?         (Answer yes or no).
        Is a third party going to be under contract to control revenues and expenditures and operate/maintain the
        project?          (Answer yes or no).

6.      I will control the site where the project will be located – for the useful life of the proposed technology.
        Attached is documentation of this control.

7.       I have satisfactory sources of revenue in an amount sufficient to provide for the operation, management,
        maintenance, and debt service of the project – for the life of the project (Answer yes or no).

IN WITNESS WHEREOF, I have executed this certification on this                      day of         , 20        .


                                                       _____________________________________________
                                                       Name of Applicant/Grantee

                                                       _____________________________________________
                                                       Printed Name of Authorized Representative of Applicant/Grantee

                                                       _____________________________________________
                                                       Signature of Authorized Representative of Applicant/Grantee



                                                  Page 10                                    Revised 1/17/13
                                         D. Operation Description
1) Describe the applicant’s total farm/ranch/business operation and the relationship of the proposed project to the
   applicant’s total farm/ranch/business operation.


2) Provide a description of the ownership of the applicant, including a list of individuals and/or entities with
   ownership interest, names of any corporate parents, affiliates, and subsidiaries, as well as a description of the
   relationship, including products, between these entities.



                        E. Financial Information for Size Determination

Attached is financial information to allow the Agency to determine the applicant’s size. All information submitted
under this paragraph has been substantiated by authoritative records. Financial size will determine the number of
points the applicant is eligible for (scoring criteria #6 – small agricultural producer – or – very small business).
Voluntarily providing tax returns is one means of satisfying this requirement and providing documentation for
scoring criteria #6.
IRS forms submitted are as follows (please check as applicable):
                  IRS form 1120 – Corporation                     IRS Schedule F – Farming
                  IRS form 1120S – “S” corporation                IRS Schedule C – Business
                  IRS form 1065 – Partnership                     IRS Form 1040

A) Rural small businesses must provide sufficient information to determine total annual receipts for and number
   of employees of the business and any parent, subsidiary, or affiliates at other locations. The information
   provided must be sufficient for the Agency to make a determination of business size as defined by SBA.

      Annual Receipts – The income or gross income (sole proprietorship) plus cost of goods sold.

    The applicant’s determination of business size is as follows:
                          IRS form 1120 – Corporation – line 11
                          IRS form 1120 S – “S” Corporation – line 6
                          IRS form 1065 – Partnership – line 8
                          IRS Schedule C – Business – line 7
                          IRS Schedule F – Farming – line 11

The applicant’s determination of business size is as follows (average of the 3 most recent tax returns):
           Annual receipts Year 1: _         ________
           Annual receipts Year 2: _         ________
           Annual receipts Year 3: _         ________
           Average annual receipts: _         ________

Total number of employees is:

The applicant has one rural location (yes or no):

                                                               OR

B) Agricultural producers: Provide the gross market value of your agricultural products, gross agricultural
   income, and gross non-farm income of the applicant for the calendar year preceding the year in which you
   submit your application.
                         IRS Form 1120 – Corporation – line 1a
                         IRS Form 1120 S – “S” Corporation – line 1a
                         IRS Form 1065 – Partnership – line 1a
                         IRS Schedule C – Business – line 1
                         IRS Schedule F – Farming – lines 3 & 4

                                    Line 9 of IRS form Schedule F divided by
      (Line 22 IRS form 1040) + (Line 33 of IRS form Schedule F) + (Line 28 and 30 from Schedule C (gross non-farm income)
                                                  Page 11                                   Revised 1/17/13
                                                    Tab E
                                                  Divider Page


                        Matching Funds Documentation 4280.116 (b) (5)


A spreadsheet identifying sources of matching funds, amounts
and status of matching funds. The spreadsheet will also include a
directory of matching funds source contact information.

Attach any applications, correspondence, or other written
communication between applicant and matching fund source.

The matching funds letter is not a letter of intent. It is a
commitment to the project for a specific amount of dollars.




Per AN 4505 (4280-B) 4-20-10 – If financial resources come from the grantee, the grantee will submit
           documentation in the form of a bank statement that demonstrates availability of funds.

           If a lender is providing financial assistance, then a commitment letter, signed by an authorized bank official
           would be needed. The letter must be:
                                   specific to the project,
                                   outline the amount of the loan, rates and terms.
              A letter of intent or a pre-qualification letter would not be acceptable.
              Letters that condition the funding on bank approval or other underwriting requirements is not acceptable.
              An acceptable condition may be based on the receipt of the REAP grant or an appraisal of property being
              completed.


          Without specific statutory authority,                     Passive third party equity contributions are
          other Federal grant awards and                            acceptable for renewable energy system
          applicant in-kind contributions                           projects, including those that are eligible for
          cannot be used to meet the matching                       Federal production tax credits, provided the
          fund requirement.                                         applicant meets the requirements of Section
                                                                    4280.112 (applicant eligibility).




                                                 Page 12                                   Revised 1/17/13
                             Applicant Name:
                   Matching Funds Documentation Spreadsheet
                             Title of Project:
                               Total Cost $

    Source of Funds            Contact:                  Dollars   Status of funds      Attachments to verify
                      Name                                                                     status
                      Address
                      Business Phone
                      Fax

1   Section 9007      Area Office:                   $             Pending award        No
    Grant                                                          of grant


2   Guaranteed 9007   Applicant:                     $             Pending award
    Loan

                      Ph: (        )   -
                      Fax: (       )   -

3   Applicant Funds                                  $             Committed            Applicant letter of
                                                                                        commitment or bank
                      Ph: (        )   -                                                statement
                      Fax: (       )   -

4   Lending                                          $
    Institution
    Loan              Ph: (        )   -
                      Fax: (       )   -

5                                                    $

                      Ph: (        )   -
                      Fax: (       )   -

6                                                    $

                      Ph: (        )   -
                      Fax: (       )   -

7   Investor Funds                                   $

                      Ph: (        )   -
                      Fax: (       )   -

                      Total Project Cost             $             (Should match
                                                                   total project cost
                                                                   on SF 424C
                                                                   located behind
                                                                   Tab A)




                                           Page 13                               Revised 1/17/13
                                                              Tab F
                                                           Divider Page


                                      Self Evaluation Score 4280.116 (b) (6)


Self-score the project using the evaluation criteria 4280.117 (c).

Use Appendix E to 4280-B or Guide 4 – Scoring Guideline to complete the                                     Guide 4 follows this
evaluation.                                                                                                 divider page.

To justify the score, submit the total score along with appropriate calculations
and attached documentation, or specific cross-references to information
elsewhere in the application.

Tab the documentation attached to the score sheet to match the scoring criteria
number. For example:

Scoring criteria #1 – tab the documentation #1
Scoring criteria #2 – tab the documentation #2
Etc. Etc.
Criteria #9 – Simple Payback per 4280.103
Renewable Energy Systems
Total Eligible Project costs (including REAP grant) divided by { Average Net Income + (Interest Expense+ Depreciation Expense)}
Average Net Income:
- All energy related revenue streams which include monetary benefits from Production Tax Credit (PTC), Renewable Energy Credit,
  Carbon Credits, revenue from byproducts produced by the energy system and other incentives that can be annualized.
- Is income remaining after all project obligations are paid (operating and maintenance), except interest and depreciation.
- Should be based on the project’s typical year income (which is after the project is operating and stabilized) projections at the time of
  application submittal.
- Does not allow Investment Tax Credits, State tax incentives or other one time construction and investment related benefits that
cannot be annualized to be included as income or reduce total eligible project costs.

Energy replacement and energy efficiency improvement project

Total Eligible Project Costs (including REAP Grant) divided by {Dollar Value of Energy Produced (or Saved)}
Dollar Value of Energy Produced or Saved incorporates the following:
- All energy related revenue streams which include monetary benefits from Production Tax Credit (PTC), Renewable Energy Credit,
Carbon Credits, revenue from byproducts produced by the energy system and, other monetary incentives that can be annualized.
- Does not allow energy efficiency improvements to monetize benefits other than the dollar amount of the energy savings the
agricultural producer or rural small business may realize as a result of the improvement.
- Does not allow Investment Tax Credits, State tax incentives or other one time construction and investment related benefits that
cannot be annualized to be included as income or reduce total eligible project costs.
(3) For flexible fuel systems, the calculation for simple payback is as follows:
   (i) Simple payback = (Total Project Costs (including REAP Grant)) divided by (Increase in Net Income + Interest Expense +
Depreciation Expense (for the project))
   (ii) Increase in income:
        (A) Is based on all flexible fuel pump related net income (the projected increase in annual net income resulting by the
installation of the project), which includes monetary benefits from Tax Credits and other credits or incentives that can be
annualized.
       (B) Is based on income remaining after all project obligations are paid (operating and maintenance), except interest and
depreciation as noted above.
       (C) Is based on the Agency’s review and acceptance of the project’s typical year income (which is after the project is
operating and stabilized) projections at the time of application submittal.
       (D) Does not allow State tax incentives or other one-time construction and investment related benefits that cannot be
annualized to be included as income or reduce total eligible project costs.




                                                         Page 14                                         Revised 1/17/13
Guide 4 – Appendix C – Scoring Guideline                                                     Page 1 of 4

            Renewable Energy and Energy Efficiency Improvement Program
                       Evaluation Criteria Scoring Guideline
                        Per 4280-B Regulation – 4280.112 (e)


 Name of Applicant:

 Type of Technology:

 Funding Request:
 Final Grant Total Score (sum of Categories 1 - 9):

 List the maximum points the applicant is eligible for under each of the following ten categories, sum the individual
 scores, and place the total in the above box under “Final Total Score.”


 (1) Quantity of Energy Replaced, Produced, or Saved
 Points may only be awarded for one category (A, B, or C).

 (A) Energy
 replacement
 If the proposed renewable energy system is intended primarily for self use by the agricultural producer or rural small
 business, and will provide energy replacement of:

 Greater than 0 but equal to or less than 25%, award 5 points.                                               Points
 Greater than 25%, but equal to or less than 50%, award 10 points.
 Greater than 50%, award 15 points.
 Determine energy replacement by dividing the estimated quantity of renewable energy to be generated over a 12-
 month period by the estimated quantity of energy consumed over the same 12-month period during the previous year
 by the applicable energy application. The estimated quantities of energy must be converted to British thermal units
 (BTU’s), Watts, or similar energy equivalents to facilitate scoring. If the estimated energy produced equals more than
 150% of the energy requirements of the applicable process(es), score the project as an energy generation project.

 Provide documentation to substantiate the score for this category below.
 Or
 (B) Energy Savings (include additional 5 points if applicable)
 (1) If the estimated energy expected to be saved by the installation of the energy efficiency improvements will be
 from:
 20% up to but not including 30%, award 5 points.                                                         Points
 30% up to but not including 35%, award 10 points.
 35% or greater, award 15 points.
 Energy savings will be determined by the projections in an energy assessment or audit.

 (2) Additional points.
 If the project has total eligible project costs of $50,000 or less AND opts to obtain a professional        Points
 energy audit, award an additional 5 points.

 Provide documentation to substantiate the score for this category below.
 Or


                                              Page 15                               Revised 1/17/13
(C) Energy generation

If the proposed renewable energy system is intended primarily for                                         Points
production of energy for sale, award 10 points.

Provide documentation to substantiate the score for this category below.

           or
(D) Flexible fuel systems(s)

If the proposed project is for one or more flexible fuel pumps, points will be awarded based on the overall percentage
of proposed flexible fuel pumps to the applicant's total retail pump inventory at the facility.

If the proposed flexible fuel pump percentage calculated is 5% or below, award 5 points                   Points

If the proposed flexible fuel pump percentage calculated is above 5% and up to, but not
including 10%, award 10 points
If the proposed flexible fuel pump percentage calculated is 10 percent and above, award 15
points
The percentage of proposed flexible fuel systems shall be calculated using the following equation:

     Equation: FFP% = (FFPx / TP) x 100
     Where:    FFP% = Proposed flexible fuel system(s), percentage.
     FFPx = Number of proposed flexible fuel pump(s) to be installed at applicants facility.
     TP = Number of proposed pumps to be installed plus the number of pumps installed and operating at the facility.


Provide documentation to substantiate the score for this category below.


(2) Environmental benefits

If the purpose of the proposed system contributes to the environmental goals and objectives of            Points
other Federal, State, or local programs, award 10 points.



(3) Commercial availability

If the proposed system or improvement is currently commercially available and replicable, award           Points
5 points.
If the proposed system or improvement is commercially available and replicable and is also
provided with a 5-year or longer warranty providing the purchaser protection against system
degradation or breakdown or component breakdown, award 10 points.
Provide documentation to substantiate the score for this category below.

(4) Technical Merit

The agency will conduct a technical review of the project. Please ensure that the applicable              Points
technical report is completed in detail. The total points possible is 35.

                                                                                    0.00
                                        Total Points from Technical Merit



                                           Page 16                               Revised 1/17/13
(5) Readiness (Grants only)
If the applicant has written commitments, prior to the Agency receiving the complete application, from the source(s)
confirming commitment of:

50% up to, but not including, 75% of the matching funds, award 5 points.                                     Points
75% up to, but not including, 100% of the matching funds, award 10 points.
100% of the matching funds, award 15 points.

Provide documentation to substantiate the score for this category below.
(6) Small Agricultural Producer/Very Small Rural Business

If the applicant is an agricultural producer producing agricultural products with a gross market value of:

less than $600,000 in the preceding year, award 5 points.                                                    Points
less than $200,000 in the preceding year, award 10 points.

OR
is a Very Small Rural Business as defined in 4280.103 (a business with less than 15 employees
and less than $1 million in annual receipts), award 10 points.

Provide documentation to substantiate the score for this category below.

(7) Simplified application
If an applicant is eligible for and uses the simplified application process or if the project has total      Points
eligible project costs of $200,000 or less, award 5 points.

Provide documentation to substantiate the score for this category below.


(8) Previous grantees and borrowers
If the applicant has not been awarded a grant or loan under this program within the 2 previous               Points
Federal fiscal years, award 5 points.

Provide documentation to substantiate the score for this category below.

(9) Simple payback

A maximum of 15 points will be awarded for either renewable energy systems or energy efficiency improvements;
points will not be awarded for more than one category.

(A) Renewable energy systems (including flexible fuel pumps)

If the simple payback of the proposed project is:
Less than 10 years, award 15 points.                                                                         Points

10 years up to but not including 15 years, award 10 points.

15 years up to and including 20 years, award 5 points.

Longer than 20 years, award 0 points.

Provide documentation to substantiate the score for this category below.


                                              Page 17                                 Revised 1/17/13
(B) Energy efficiency improvements

If the simple payback of the proposed project is:
Less than 4 years, award 15 points.                                                          Points
4 years up to but not including 8 years, award 10 points.
8 years up to and including 12 years, award 5 points.
Longer than 12 years, award 0 points.

Provide documentation to substantiate the score for this category below.




                                            Page 18                        Revised 1/17/13
                                                          Tab G
                                                        Divider Page


                                          Energy Audit
                   (for Energy Efficiency Projects Only) 4280.116 (b) (7) (i) (B)


For energy efficiency improvement projects with total eligible
project costs greater than $50,000, an energy audit must be
conducted by or reviewed and certified by and energy
auditor.

For energy efficiency improvement projects with total eligible
project costs of $50,000 or less, an energy assessment or an
energy audit may be conducted by either an energy assessor
or an energy auditor.


Energy audit – A report conducted by a Certified Energy Manager or Professional
Engineer that focuses on potential capital intensive projects and involves detailed
gathering of field data and engineering analysis. The report will provide detailed project
cost and savings information with a high level of confidence sufficient for major capital
investment decisions. It will estimate costs, expected energy savings from the subject
improvements, and dollars saved per year. The report will estimate weighted-average
payback period in years.

Energy assessment – A report conducted by an experience energy assessor,
certified energy manager or professional engineer assessing energy cost and
efficiency by analyzing energy bills and briefly surveying the target building, machinery,
or system. The report identifies and provides a savings and cost analysis of low-
cost/no-cost measures. The report will estimate the overall costs and expected energy
savings from these improvements, and dollars saved per year. The report will estimate
weighted-average payback period in years.




                                                      Page 19                                Revised 1/17/13
                                                           Tab H
                                                        Divider Page


                                                Technical Report
                                            (required of every project)
                                           4280.116 (b) (7) (i) (A) and (C)


The Technical Report must be prepared in accordance with Appendix A, for
projects with total eligible project costs of $200,000 or less.
The Technical Report must demonstrate that the renewable energy system or
energy efficiency improvement project can be installed and perform as intended in a
reliable, safe, cost effective, and legally compliant manner.
All information provided in the Technical Report will be evaluated against the
requirements provided in Appendix A of this subpart. Any Technical Report not
prepared in the following format and in accordance with Appendix A, where
applicable, will be penalized under scoring for technical merit.
           Technical Report Requirements –http://www.rurdev.usda.gov/WI_RBS_Energy.html

  Technical Report templates are available for biomass, energy efficiency, solar, solar thermal, and
                     wind. Please use contact information on Page 1 to request.

(1) Qualifications of the Project Team – The applicant has described the project team service providers,
     their professional credentials, and relevant experience. The description supports that the project team
     service, equipment, and installation providers have the necessary professional credentials, licenses,
     certifications, or relevant experience to develop the proposed project.
(2) Agreements and Permits – The applicant has described the necessary agreements and permits
     required for the project and the schedule for securing those agreements and permits.
(3) Energy or Resource Assessment – The applicant has described the quality and availability of a
     suitable renewable resource, or an assessment of expected energy savings for the proposed system.
(4) Design and Engineering – The applicant has described the design, engineering, and testing needed
     for the proposed project. The description supports that the system will be designed, engineered, and
     tested so as to meet its intended purpose, ensure public safety, and comply with applicable laws,
     regulations, agreements, permits, codes, and standards.
(5) Project Development Schedule – The applicant has described the development method including the
     key project development activities and the proposed schedule for each activity. The description
     identifies each significant task, its beginning and end, and its relationship to the time needed to initiate
     and carry the project through to successful completion. The description addresses grantee or borrower
     project development cash flow requirements.
(6) Project Economic Assessment – The applicant has described the financial performance of the
     proposed project, including the calculation of simple payback. The description addresses project costs
     and revenues, such as applicable investment and production incentives and other information to allow
     the assessment of the project’s cost effectiveness.
(7) Equipment Procurement – The applicant has described the availability of the equipment required by
     the system. The description supports that the required equipment is available, and can be procured and
     delivered within the proposed development schedule.
(8) Equipment Installation – The applicant has described the plan for site development and system
     installation.
(9) Operations and Maintenance – The applicant has described the operations and maintenance
     requirements of the system necessary for the system to operate as designed over the design life.
(10) Dismantling and Disposal of Project Components – The applicant has described the plan for
     dismantling and disposing of project components at the end of their useful lives and associated wastes.




                                                      Page 20                                       Revised 1/17/13

				
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